(Re)Thinking the Corporeality of
HIV/AIDS in the Post-HAART Era:
A Critical Perspective
MARILOU GAGNON
Introduction
Looking back at our history, we recognize that the human body is an important generator and recipient of tech-nology.[1] As part of a wider interactive system, human beings have been known to respond to their internal and external environments through the practical application of knowledge and techniques, also known as technology.[1] In light of the advancements that have taken place in the twen-tieth century, we are now entering an era of great possibilities in the fi elds of science and medicine. In fact, we are living in a society that is more technologically dominated than ever before, one in which “productive techniques and knowledge
are moving inwards, to invade, reconstruct and increasingly dominate the very contents of the body”.[1] Therefore, there is a defi nite need to refl ect on the uncertainty of what the body is and what it will become in the presence of technol-ogy and more precisely, biotechnologies. The goal of this paper is to discuss the interface technology-body as it relates to the fi eld of HIV/AIDS and the in/corporation of Highly Active Antiretroviral Therapy (HAART). Based on the work of Plato and Jacques Derrida, the concept of pharmakon will be explored and situated within the interface technology-body. The main objective will be to discuss how HIV medications as pharmakon are involved in the creation of new forms of corpo/reality for people living with HIV/AIDS, namely the cyborg and the mutant.
Revisiting Plato’s pharmacy: the pharmakon
from Plato to Derrida
Pupil of Socrates and founder of the Athenian Academy, Plato (428-347 BC) is an inaugural fi gure in Western phi-losophy and he remains widely infl uential in contemporary
2
Abstract
The goal of this paper is to expose the hidden facet of the interface technology-body through a theoretical
application of the concept of pharmakon to the fi eld of HIV/AIDS. Based on the works of Plato and Jacques
Derrida, the concept of pharmakon is explored and situated within the interface technology-body. Thus, the
main objective of this theoretical piece is to discuss how HIV medications as pharmakon are involved in the
creation of new forms of corpo/reality for people living with HIV/AIDS, namely the cyborg and the mutant.
Inspired by Haraway’s cyborg and Cronenberg’s mutants, the ambivalent quality of technology is explored
through the technological fi gure and the monstrous fi gure, two different but complementary representations
that expose the bodily experiences of Highly Active Antiretroviral Therapy (HAART).
thinking.[2] Through his work, Plato distinguishes philosophy as a subject and a method by insisting on its difference from other forms of thought such as rhetoric and poetry.[3] Often described as a literary philosopher, Plato is famous for his use of dialectics as a method to structure and to formulate his arguments.[3] His writing style is unique because it is structured in a dramatic form, either as a monologue or a dialogue, and it is typically centered on Socrates as the ideal fi gure of philosophy.[3] In the Phaedrus, one of many Pla-tonic dialogues, a fi ctional conversation between Socrates and Phaedrus explores the relative merits of the lover and the non-lover (as sexual partners and thinkers), of rhetoric and philosophy and of speech and writing.[2] In a specifi c segment of this dialogue, Socrates attempts to convince Phaedrus that speech is superior to writing by referring to the Egyptian myth of Teuth, an inventor-god whose creations include numbers, calculation, geometry, astronomy, games and writing.[2] In the legend, we encounter Teuth’s character during the exhibition of his arts to Thamus (Ammon), the great god-king of all Egypt.[2,4] When it comes to writing, Teuth says: “This discipline, my King, will make Egyptians wiser and will improve their memories: my invention is a recipe (pharmakon) for both memory and wisdom”.[4] To this declaration the King replies: “Teuth, my master of arts, to one man it is given to create the elements of an art, to another to judge the extent of harm and usefulness it will have for those who are going to employ it. […] The fact is that this invention will produce forgetfulness in the souls of those who have learned it because they will not need to exercise their memories, being able to rely on what was written, using the stimulus of external marks that are alien to themselves […]”.[4] For King Thamus (Ammon), writing (pharmakon) is not a remedy but a poison for the memory and the wisdom of those who rely on this art (techne). In Plato’s Phaedrus, the pharmakon introduces itself into the dialogue with the richness and the ambivalence of its meaning as both a rem-edy and a poison. However, it remained unexplored in its original form, as an “undecidable” concept that inhabits both the curative and the poisonous, for many centuries before Jacques Derrida was able “to detect the play of undecidabil-ity in the foundational texts of Plato”.[2]
Jacques Derrida (1930-2004) is a contested philosopher who has profoundly infl uenced the poststructuralist movement.[5] “Best known for having forged the term “deconstruction”, Derrida follows the work of Nietzsche and Heidegger in elaborating a critique of Western metaphysics, by which he means not only the Western philosophical tradition but every-day thought and language as well”.[6] In Plato’s pharmacy,[4]
Jacques Derrida formulates a critique of Western philosophy and literature by deconstructing the Phaedrus as it symbolizes a longstanding tradition of “logocentrism” – the domination of the spoken word over the written word.[6] By focusing on the translation of pharmakon, Derrida displays how Western thought is profoundly structured in terms of dichotomies or polarities: “good vs. evil, being vs. nothingness, presence vs. absence, truth vs. error, identity vs. difference, mind vs. matter, man vs. woman, soul vs. body, life vs. death, nature vs. culture, speech vs. writing, and [remedy vs. poison]”.[6] Through Derrida’s analysis, we come to understand that dichotomies are more than oppositional entities as they are positioned along a hierarchical order that refl ects politics of domination – politics of meaning.[6] As such, the pharma-kon – as both remedy and poison – is caught in a chain of signifi cations that is not primarily grounded in the intention of Plato, but rather in what is left unsaid through the play of words.[4] As demonstrated by Jacques Derrida, the common translation of pharmakon into languages that are the heirs and depositaries of Western metaphysics is as violent as it is impotent: “it destroys the pharmakon but at the same time for-bids itself access to it, leaving it untouched in its reserve”.[4] For many centuries, Plato’s pharmakon has been confi ned to a vocabulary (recipe, remedy, philter, receipt, cure) that neu-tralized its ambivalence, decontextualized its meaning and consequently, prevented its interpretation. Through the work of Jacques Derrida, the pharmakon becomes an ambiguous word that uncovers hidden meanings in Plato’s work and in the settings of the Phaedrus.[7] However, Derrida’s goal is not to reconstitute the entire chain of signifi cations of the pharmakon but only some of their meanings, and some of their effects, most of which are related to the Platonic prob-lematic of writing.[7]
“In addition to using the word [pharmakon] to denote medic-inal remedy or poison, Plato like other ancient Greeks, used [it] to mean a host of other things, such as pictorial colour, painter’s pigment, cosmetic application, perfume, magical talisman and recreational intoxicant”.[7] In Plato’s pharmacy, writing as pharmakon is simultaneously taken away and taken from the myth of Teuth to explore its undecidability and ultimately, to formulate a critique of Plato’s oppositions which are expressed through the mouth of King Thamus (Ammon): “speech is good vs. writing is bad, true memory is internal vs. written reminding is external, speech carries the essence of knowledge vs. writing carries the appearance of knowledge, spoken signs are living vs. written marks are lifeless”.[2,4] For Jacques Derrida, the opposition between hypomnesis (re-memoration, recollection, consignation) and
mneme (living, known memory) is a response to Plato’s own suspicion of the pharmakon (writing).[4] It is also indicative of the philosophical debates that were taking place in ancient Greece between the philosophers (those who know/speak) and the sophists (those who appear to know/write). The dia-logue between Teuth and King Thamus (Ammon) reveals that the remedy and the poison “are not simply opposed in their meanings but are arranged in a hierarchical order which gives the fi rst term priority, in both the temporal and the qualitative sense of the word”.[6] In deconstructing the myth of Teuth, Derrida reveals the ambiguity of the pharmakon (writing) as both a remedy for hypomnesis and a poison for mneme, and the politics involved in the translation of the pharmakon as a remedy.[4] In doing so, he recognizes the ambivalent quality of the pharmakon (writing) by revealing its capacity to be simultaneously benefi cial and detrimental – to be undecid-able.
Technology and body: HIV medications as
phar-makon
“At the close of the twentieth century, many predicted that “we” were entering a “biotech century”, an age of marvelous yet troubling new medical possibilities”.[8] Far from being the presage of a distant reality, this statement reveals that the biotech movement is nothing more than a continued effort to surpass the limitations of the human body.[1] Yet, it also implies that the twenty-fi rst century signals the coming together of biology and technology in the “fl esh machine”[9] – a phenomenon that is both promising and disturbing for the human body. The more we gain control over the human body, the more uncertain it becomes as the boundaries between fl esh and technology are rapidly vanishing.[10] Therefore, “the idea of technological bodies […] raises the possibility that spatial and functional arrangements of the organic prop-erties of our bodies have been altered in line with the struc-tures of society, and to an extent challenges the conventional notions of what it is to be and have a body”.[1] According to Klugman,[11] medicine is an essential gatekeeper in deter-mining which human-machine connections to permit and to develop. As a result, it is actively involved in the production, the prescription, and the consumption of biotechnologies – “biological procedures and techniques that seek to transform the living body” [translation].[12] By defi nition, medications “are substances that have the capacity to change the con-dition of a living organism” and as a result, they constitute a form of biotechnology.[13] While medications are rarely examined as part of the larger framework of technoscience studies, they should be considered as technologies of the body because “the often seamless incorporation of pharmaceutical
technologies within the corporeality of bodies demonstrate the seemingly non-existent boundaries between technolo-gies and bodies literally and discursively”.[14] However, the interface technology-body is hardly ever discussed in rela-tion to medicarela-tions, and most importantly in the presence of the all-encompassing “therapeutic” discourse.
As powerful technical and symbolic devices, medications acquire a force and a status in society.[13] They are not only the products of human culture but the producers of it “as vehicles of ideology, facilitators of self-care, and perceived sources of effi cacy”.[13] As such, individuals use and profes-sionals prescribe medications according to meanings – ema-nating from a complex psycho-social-cultural matrix subject to constant revision – which they attribute to health, illness, to the body, and to their identity. These meanings are pro-foundly “guided by imperatives of production, consumption and order under the guiding principle of effi ciency”.[9] Much like Teuth’s pharmakon, the medication has traditionally been (re)presented as a remedy to prevent the failures of the human body, to improve its functions and to surpass its limitations: the medication is a recipe (pharmakon) for human survival and longevity. Therefore, it must be confi ned to a vocabu-lary (recipe, remedy, philter, receipt, cure) that neutralizes its inherent ambivalence, decontextualizes its meaning and consequently, prevents its interpretation beyond curative effi cacy. Yet, Martin[15] notes that medications are typically regarded with ambivalence and are usually surrounded with two sets of meanings – one positive (remedy) and one nega-tive (poison). Interestingly, she suggests that within the West-ern pharmakon, the negative facet of medications and their negative meanings are displaced to the side and kept out of awareness.[15] However, because medications are used and their effects resonate over time throughout individuals and collectivities, their meanings change and can no longer be viewed through one pole (the curative pole) of the interface technology-body.[16] In the fi eld of HIV/AIDS, the use and the effects of Highly Active Antiretroviral Therapy (HAART) have drastically changed over the past decade. The mean-ing of HAART has also been profoundly affected by the lip-odystrophy syndrome, a body-disfi guring syndrome featuring adipose tissue depletion and accumulation in specifi c areas of the body such as the face, the upper and lower extremities, the buttocks, the breasts, and the dorsocervical spine.[17] In light of this disturbing phenomenon, there is a defi nite need to critically examine how HIV medications (as pharmakon) are currently re-crafting the interface technology-body. “In modern medicine, therapeutic substances are invested with the capacity and mission to either cure, prevent or
manage illness, while illness, in turn, opens up bodies to the presence and powers of these substances”.[18] Therefore, the discovery of the human immunodefi ciency virus (HIV) was the very fi rst step in developing a pharmaceutical response to the HIV/AIDS epidemic.[19] It not only opened up the body to the presence and powers of therapeutic substances but also secured HIV infection as a disease in need of cura-tive response.[20] Since then, the introduction of Highly Active Antiretroviral Therapy (HAART) and the development of medical technologies (viral load, CD4+ count, genotype, and phenotype) have generated a “scientifi c computation” of the HIV/AIDS illness which excludes, and often confl icts with the lived experience of HIV-positive individuals.[21] “For some, it may seem that HIV medications have so success-fully altered HIV/AIDS from a lethal infection, to a potentially manageable chronic illness that there is no need to contest the existing terrain”.[22] However, the initial optimism that sur-rounded HAART more than a decade ago is rapidly vanishing as the interface technology-body is producing results that are confl icting and highly ambivalent.[23] While antiretroviral therapy is undeniably successful in preventing the replica-tion of the virus, its restorative power is complicated by its manifold transformative potential to produce unpredictable results on the bodies of people living with HIV/AIDS.[18] Paradoxically, most of the unintended effects of antiretroviral therapy, including the disfi guring effects of lipodystrophy, are caused by its optimal use as a remedy.[24] Therefore, the adverse outcomes of HIV medications pose a signifi cant challenge to the “normal” therapeutic sequence (disease-therapy-outcome) by revealing that HIV medications are as much poisonous as they are curative.[18]
According to Walby[25], “any biotechnological intervention inscribes itself into a complex dynamic of corporeal anima-tion and relaanima-tionship, which redistributes its intended [and unintended] effects according to its own shifting logic”. In the fi eld of HIV/AIDS, “lipodystrophy is a striking example of a particular biotechnical inscription being processed and redistributed by a body in unintended ways”.[18] As a signifi cant iatrogenic effect, the lipodystrophy syndrome demonstrates how the in/corporation[26] of HIV medications is a process that is “indeterminate rather than predictable, contextual rather than causal”.[18] Much like Derrida’s phar-makon, HAART cannot be discussed in terms of the dichoto-mies that characterize the therapeutic discourse: good vs. bad, therapeutic vs. toxic, desired effects vs. adverse effects. Instead, we need to recognize HIV medications as both poisonous and curative and acknowledge their “capacity to be benefi cial and detrimental to the same person at the
same time”.[18] As suggested by Derrida, the sole interpreta-tion of HAART as curative “erases on a certain surface of its functioning, the ambiguity of its meaning as pharmakon”.[4] The remedy evokes the “transparent rationality of science, technique, and therapeutic causality, thus excluding […] any leaning toward the magic virtues of a force whose effects are hard to master, a dynamics that constantly surprises the one who tries to manipulate it as master and as subject”.[4] By obscuring the poisonous pole of HIV medications, “bio-medicine strives to master the indeterminacy and excess, the transgressions of pharmakon, the shadow that haunts the tradition and threatens to undo its work”.[18] Whether they are assimilated into the logic of biomedicine or construed as contradictory to it, the unintended effects of HIV medications partly dislocate the restorative value inherent to the interface technology-body.[18] Consequently, the designation of lip-odystrophy as a side effect of HIV medications is part of a broader strategy that aims at displacing the poisonous to the side and keep it out of awareness – out of meaning.[15] Much like Teuth’s pharmakon, Highly Active Antiretroviral Therapy (HAART) has been presented by the scientifi c community as a recipe for the therapeutic management of HIV/AIDS since its introduction in 1996. Looking back at Plato’s pharmacy, it is quite obvious that the stated intention of Teuth (herein rep-resenting the scientifi c community) is precisely to stress the worth of his product; thus, “he turns the word [pharmakon] on its strange and invisible pivot, presenting it from a single one, the most reassuring of its pole”.[4] The response of king Thamus (Ammon) informs us about the hidden meaning of the pharmakon, by suggesting that its harm and usefulness are not to be judge by its creator but rather by those who are going to employ it (e.g. people living with HIV/AIDS). Inter-estingly, Jacques Derrida points out that “Plato is suspicious of the pharmakon in general; even in the case of drugs used exclusively for therapeutic ends, even when they are wielded with good intentions, and even when they are as such effec-tive”.[4] In light of Plato’s pharmacy, Derrida considers that “there is no such thing as a harmless remedy [because] the pharmakon can never be simply benefi cial.[4]
Technology and body: re-crafting the corpo/
reality of HIV/AIDS
Looking back at our history, one is forced to recognize that technology has exerted a profound impact on the bodies and the environments of human beings.[1] As part of their response to their external and internal environments, human beings have changed themselves and their physical capaci-ties through the practical application of knowledge and techniques (technology).[1] In recent years, the in/corporation
of biotechnologies has proven itself to be a promising way to penetrate the fl esh of the living organism and to change its condition.[13] As such, “technoscience and the biomedi-cal industry complex (e.g. hospitals, clinics, “hard science” laboratories, pharmaceutical companies) have increasingly infi ltrated and re-formed the conceptions of health, illness, the body and what it means to be human”.[14] In the fi eld of HIV/AIDS, the introduction of Highly Active Antiretroviral Therapy (HAART) has transformed the human body into a hybrid of living material and chemical substances.[18] More importantly, “its use has generated new and durable links between humans and biotechnology, productive links that defi ne diseases and create new identities by reorganizing the bodies [of people living with HIV/AIDS]”.[18] While the boundaries between fl esh and technology are rapidly vanishing, very few authors consider the uncertainty of what the body is and what it will become in the presence of HIV medications. Yet, “when technologies interact with the specifi cities of both bodies and subjectivities, a multitude of possibilities arise”,[14] such as the creation of new forms of corpo/reality for people living with HIV/AIDS, namely the cyborg and the mutant.
The human-machine connection: people living
with HIV/AIDS as cyborgs
The term cyborg (the cybernetic organism), was fi rst intro-duced by Manfred E. Clynes and Nathan S. Kline in a 1960 article on humans in space.[27] At that time, both scientists were defi ning the cyborg as a self-regulating man-machine system, an organism in which were incorporated exogenous components to extend self-regulatory control functions and as such, promote an optimal adaptation to new environ-ments (mainly space).[27] Essentially, Clynes and Kline used the term cyborg to designate “an artifi cially enhanced [self-regulating] human being who was capable of surviving in space or on other planets without the need of an Earthlike biosphere”.[11] Since 1985, the concept of the cyborg has acquired additional meanings through the infl uential work of Donna Haraway[28-30] and the publication of the famous Manifesto for Cyborgs.[28] According to Haraway, “the cyborg is a cybernetic organism, a hybrid of machine and organism [and] a creature of social reality as well as a crea-ture of fi ction”.[29] The cyborg is a metaphorical entity that restructures socialist-feminist politics around science and technology, and provides a new space to redefi ne the bodies and identities of women.[29] It is a creature that inhabits a post-gender world – it is neither male nor female – since it has no origin in the Western world and the dichotomized structure through which human beings are conditioned as
man or woman.[29] Using the cyborg imagery, Haraway redefi nes the interface technology-body as unifying, revolu-tionary and emancipating for the world wide web of gen-derless techno-beings. Based on the idea that cyberculture provides an opportunity to alter our current view of the social relations of science and technology, the Manifesto for Cyborgs is controversial because it not only asks women to redefi ne their subjectivities but “to explore the potential and the risk of being cyborg – neither wholly man, woman, nor machine”.[31] Yet, Haraway’s work “is rarely, if ever, located, problematised or discussed critically”.[31] This is the case even though the cybernetic organism has only been pre-sented through the most reassuring of its pole – as a recipe (pharmakon) to become a posthuman. Since the publication of the Manifesto, the cyborg “has played a key role in the ongoing under-recognition and under-theorisation of gender issues on the part of mainstream cybertheorists”.[31] On the other hand, it has provided insightful discussions on what the human body is and what it will become in the biotech century. While, “the cyborg horrifi es some people and thrills others”,[32] it remains a provocative fi gure that exposes interface technology-body in unparalleled ways.
As a key mediator of the human-machine connection, medicine is an important producer of cyborgs – of coupling between technologies and bodies.[10-11,28-29,33-34] How-ever, while the current progress of modern medicine offers us unprecedented control over our bodies, it also generates a growing fear of the iatrogenic effects of biotechnologies.[10] Haraway notes that the reconfi guration of the human body by science and technology evokes a strong ambivalence because “it is not clear who makes and who is made” through the connection human-machine.[29] As such, the fabricated union between organism and machine is not without risks and could eventually lead to an “irreversible dehumaniza-tion”,[35] although it seems today that we are less of a person without it.[15] Within the “technological clinic” or the “transhuman bodyshop” of modern medicine,[10] being a cybernetic organism is considered to be a desirable state, one that outweighs its potential risks. However, “the cyborg is a contested location”[36] since it is all “about transgressed boundaries, potent fusions, and dangerous possibilities” between animal/human, organism/machine and physical/ non-physical.[29] Considering the ambiguous quality of the interface technology-body we ask: Could the cyborg ever become an unwelcome fi gure in society? Despite the fact that Donna Haraway confi rms the existence of good cyborgs and bad cyborgs in a 1990 interview, those two fi gures have not (to our knowledge) been explored by cybertheorists.[36]
Based on these fi ndings we ask: Could the machine even-tually be threatening for the cyborg? If so, how would the cyborg body react in the presence of unintended effects of technology? What becomes of the hybrid when technology rebels against the complexity of the human body? How can the cyborg be in control (as suggested by Haraway[29]) when it is essentially defi ned as an “unbounded creature”?[26] Donna Haraway argues that we, as cybernetic organisms, can be responsible for machines because “they do not dominate or threaten us”.[29] For people living with HIV/AIDS, this statement is very problematic because it does not recognize the ambiguous quality of the interface technology-body and in doing so, denies the risks of being a cyborg. It is also contra-dictory to Haraway’s previous statements on the uncertainty of the cyborg body and the inexplicable outcomes of the human-machine connection.[29] Since the advent of Highly Active Antiretroviral Therapy (HAART), medicine can turn HIV-positive individuals into cyborgs by restoring lost immu-nity through the suppression of viral replication, normalizing the internal and the external confi guration of the HIV-positive body, reconfi guring the immune system as a battlefi eld for survival and enhancing the physical capacities of those who can no longer regulate their own immunity.[37] Reconfi gured by technology, the bodies of people living with HIV/AIDS are coded automatons that must be read, regulated, measured and controlled through biotechnologies and medical technolo-gies (viral load and CD4+ measurements/monitoring, genetic profi ling, genotyping / phenotyping).[18,24] Subsequently, people living with HIV/AIDS are constantly “disassembled and reassembled”[29] under the technological gaze of medi-cine to secure their status as legitimate cybernetic organisms. Acting as the mediator of the human-machine connection, the primary goal of HIV medicine is to produce cyborgs that in/corporate the benefi ts of biotechnologies, namely longev-ity and survival. However, the iatrogenic effects of HAART challenge the one and only representation of the cybernetic organism as a desirable product of the interface technology-body. Consequently, people living with HIV/AIDS are not only cyborgs in-the-making but troubling fi gures of otherness that defi ne the connection human-machine as a site of dif-ferentiation.
With the introduction of Highly Active Antiretroviral Therapy (HAART), becoming cyborg is indicative of a new mode of existence for people living with HIV/AIDS,[38] one that is being defi ned by the unintended effects of technology (e.g. lipodystrophy). In other words, “continued use of [HIV medi-cations] generates new and durable links between humans and biotechnology, productive links that defi ne diseases and
create new identities by reorganizing bodies”.[18] Therefore, the HIV-positive cyborg is a “contested location”[36] since it is all about transgressed boundaries between technology and body, potent fusions between curative and poisonous and dangerous possibilities between organism and machine. [29] Disfi gured by the unintended effects of HIV medica-tions (lipodystrophy), the cybernetic organism redefi nes biotechnologies as pharmakon – neither remedy nor poison. It embodies the unpredictability of the interface technology-body along with the benefi ts and the risks of being cyborg – neither human nor machine. By calling attention to the unintended effects of biotechnologies, the visibility of the HIV-positive cyborg disrupts social order by invading the reality and the imagination of individuals and collec-tivities.[24] As a social creature, this cybernetic organism is extremely ambivalent – neither infectious nor safe – because it threatens the boundaries between the sick and the healthy. More than a decade after the introduction of Highly Active Antiretroviral Therapy (HAART), people living with HIV/AIDS have become the unwelcome cyborgs of society – regener-ated fi gures of monstrosity.
Regenerating the monster: people living with
HIV/AIDS as mutants
Throughout history, the monstrous fi gure has always been positioned outside the course of nature[39-40] because it car-ries “the weight of not just difference, but of différance”.[41] In other words, “monsters speak to both radical otherness that constitutes an outside and to the difference that inhabits identity itself”.[42] As an object of knowledge and a mythi-cal creature, the monstrous fi gure challenges the boundaries of the normatively embodied self in ways that confi rm and secure the limits of the human body.[29,42-43] Therefore, “the monster is always whatever we are not”[43] and it con-tinues to change as human beings evolve over time.[43] In light of the technological advancements that are taking place in the twenty-fi rst century, the monstrous fi gure is going through yet, another transformation that mirrors the recon-fi guration of human beings as cyborgs. For Shildrick[41] and Haraway[29-30], the cybernetic organism can be interpreted as monstrous because it is a creature that challenges what it means to be human and to have a body. However, the cyborg “has very little connection with the familiar and mythical secure world of humanism”[41] in which the monstrous fi g-ure is constructed as the natural symbol of otherness. Since Aristotle, the term monstrosity has been used “to describe forms of corporeal excess, defi ciency or displace-ment, not just those bodies which are malformed by disease, accident, or birth, but widely to depict all beings that are
deviation from the common course of nature”.[42] Contrarily to the cyborg, the monster symbolizes nature’s faux pas in the fabrication of the human body and consequently, the powerlessness of human beings against the complexity of their own bodies. Since Haraway’s cyborg is clearly not a product of nature, defi ning it based on a term (monster) that comes from a longstanding tradition of naturalist thought is ultimately hazardous. Subsequently, there is a need to distinguish the monster from the cybernetic organism when examining the interface technology-body even though they are both complementary fi gures that contribute to a deeper understanding of the in/corporation of HIV medications and the involvement of this process in the creation of new forms of corpo/reality. By considering the monstrous fi gure as part of a new existence for people living with HIV/AIDS, the goal is to move beyond the cyborg discourse in order to recognize the complexity of living organisms and therefore, the partici-pation of nature in the interface technology-body.
In the midst of the twentieth century, the traditional mon-strous fi gure vanished from popular culture and was replaced by a new mythical creature known as the mutant. However, what appeared to be an important change in Western imagi-nation was nothing else than a transformation of the outdated monster into a creature that embodied the uncertainty of the upcoming technological era. While the mutant took on a life of its own as a fi ctional character, it also became a central topic to modern science and medicine. Ever since the discovery of the human genome sequence in 2001, its constituents have become the most promising (and disturb-ing) sites for technological intervention.[44] The concept of mutation has also acquired new meanings because of a greater understanding of human genetics and its involvement in the “limitations” of the human body (e.g. illness, defor-mities, intellectual disabilities, defi ciencies).[44] In addi-tion, mutants (individuals living with biological mutations) have become valuable subjects in the quest to identify the perfect or normal genome.[44] So far, a small minority of the mutations that alter the meanings of genes have been recognized as benefi cial for the evolution of the human race, and through this process the majority of living mutants – those whose genes are naturally or artifi cially altered – have been represented as ambiguous creatures that challenge the core of our existence (human genome).[44] Over the past twenty-fi ve years, the human immunodefi ciency virus has become an important producer of living mutants by immor-talizing itself into the genes of otherwise “normal” human beings.[19] At a cellular level, the HIV virus is transported into the nucleus of the host cell (T-lymphocyte) in order to
insert its double-stranded proviral DNA (deoxyribonucleic acid) within the DNA of the host cell chromosomes.[19,45] By reprogramming the genes of the T-lymphocyte cell, the human immunodefi ciency virus creates its very own fac-tory and consequently, secures its capacity to replicate and survive within the human body. However, like many other retroviruses, the HIV virus is prone to mutate at an aston-ishing rate in the course of its replication – a phenomenon that allows the HIV virus to evolve constantly as environ-mental pressures change in the host (e.g. medications, vac-cines or illness).[19,45] Scientists have recently discovered that the exposure of the human immunodefi ciency virus to antiretroviral agents causes permanent changes of the HIV genome (mutations) and leads to the emergence of drug-resistant variants that are no longer responsive to therapeutic measures.[46] Therefore, the cellular pathogenesis of HIV has set in motion a biological process through which people living with HIV/AIDS have developed undesirable mutations that attest to the complexity of the human body. In light of the advancements that have taken place in the fi eld of HIV/ AIDS, namely the use of HIV medications, people living with HIV/AIDS have become more than living mutants, they are the monstrous fi gures of the technological era.
In popular culture (literature, movies, television), the monster has always been portrayed as a character that evokes fear and fascination, a creature that is far from being “normal” but similar enough to disturb the normatively embodied indi-vidual.[42] Until the 1980s, the concept of monstrosity was a recurrent theme in Western cinematography with the creation of monstrous fi gures that were always positioned outside the course of nature because of their physical otherness. Apart from Mary Shelley’s Frankenstein, very few creators were willing to explore the monster as a product of science and technology and as a hybrid of human and machine.[47] As a result, the work of cinematographer David Cronenberg is one of great interest when attempting to explore the monstrous fi gure of the technological era, namely the fi ctional character of the mutant.[48] In the majority of his movies, Cronenberg represents the human body as an object of experimentation that can be manipulated, transformed, ripped apart and bro-ken down.[48] As such, his characters are typically generated from an experimental process that expands the limits of the human body to a point where it is no longer controllable or habitable.48 For Cronenberg, mutants are living beings or objects that have undergone a transformative process – either a biological mutation or a metaphorical mutation.[48] Based on movies such as “The Fly” from 1986, “Dead Ringers” from 1988, “Scanners” from 1981 and “The Brood” from
1979, Cronenberg’s mutants are represented as either male or female.[48] While there is an interesting connection to be made between his construction of the female mutant and the longstanding tradition of describing women’s bod-ies as monstrous,[47] his conceptualization of the interface technology-body is of greater use to the current discussion. For David Cronenberg, the mutation is related to the prac-tice of medicine and its manipulation of the human body through technology.[48] With regards to the unintended effects of HAART, namely the lipodystrophy syndrome, the similarities between the living mutants of HIV medicine and Cornenberg’s fi ctional fi gures are both disturbing and alarming. Similarly to Jeff Goldblum’s character in “The Fly”, people living with HIV/AIDS are currently experiencing a physical transformation as a result of unexpected “experi-mental mutations”.[48] Caused by an unknown pathogen-esis, lipodystrophy is an unforeseen product of science and medicine that causes an abnormal redistribution of adipose tissue in the body by disturbing the functional and structural integrity of adipocytes. As a result of the unintended effects of HIV medications, people living with HIV/AIDS undergo a troubling metamorphosis, one that is worthy of a horror script à la Cronenberg: “[…] I would look at myself in the mirror and not see the same person I used to be”;[49] “[…] I don’t see my body as before. If I look at myself in the mirror I see it old, it’s wasting”;[49] “[…] almost alienated from my body there’s this inbuilt distance between who you are now and what you’re seeing […]”.[50] From Haraway’s cyborg to the extreme representation of Cronenberg’s mutants, technology is pharmakon because it serves the seed of life as a remedy and the seed death as a poison – it is ultimately the pharma-kon that signals the end of what it means to be and have a body.[4]
Final remarks
The goal of this paper was to expose the hidden facet of the interface technology-body through a theoretical application of the concept of pharmakon to the fi eld of HIV/AIDS. Based on the works of Plato and Jacques Derrida, this interpretation of the pharmakon served as a pivotal element in formulating a critique of the in/corporation of Highly Active Antiretroviral Therapy (HAART). The main objective was to discuss how HIV medications are involved in the creation of new forms of corpo/reality for people living with HIV/AIDS. Inspired by Haraway’s cyborg and Cronenberg’s mutants, the ambivalent quality of technology was explored through the technological fi gure and the monstrous fi gure, two different but comple-mentary representations that expose the bodily experiences of HAART. What this essay argues is that the pharmakon – as
both remedy and poison – is caught in a chain of signifi ca-tions that is not solely contained in what we have presented but rather in what was left unsaid voluntarily through the play of words.[4] Underneath our interpretation of the interface technology-body are the experiences of people living with HIV/AIDS who in/corporate the essence of the pharmakon – the promise of a remedy, the dangerousness of the poison, the ambivalence of life itself and the death of what it means to be a normal human being.
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Acknowledgments
I would like to acknowledge the fi nancial support of the Canadian Institutes of Health Research (CIHR). I would also like to thank those who have provided valuable feedback, especially Dr. Dave Holmes, Dr. Meryn Stuart, and Dr. Denise Moreau.
Contact Information for Author: Marilou Gagnon RN, PhD (candidate) CIHR Doctoral Fellow
University of Ottawa Faculty of Health Sciences School of Nursing 451 Smyth Road
Ottawa, Ontario, K1H 8M5 Canada
